Lhakpa Quendren

Many women in the productive age group of 15 to 49 who experienced incomplete miscarriages had unintended pregnancies, according to a recent study on the “Clinico-demographic profile of incomplete miscarriage.”

Incomplete miscarriage, according to the World Health Organization (WHO), refers to a condition where some fetal or placental tissue remains in the uterus following the partial expulsion of pregnancy contents.

The observational study, conducted by Karma Lhaden from Khesar Gyalpo University of Medical Sciences and Dr. Sonam Gyamtsho from the National Referral Hospital (JDWNRH), included 132 women with incomplete miscarriages at JDWNRH from February 2020 to February 2021.

The study revealed an incomplete miscarriage rate of 25.4 per 1,000 women aged 15-49 at JDWNRH. The most prevalent age group was 21-30, accounting for 54.5 percent of cases, with patients ranging from 19 to 46 years old.

About 80 percent (105 patients) reported unplanned pregnancies, with 73.5 percent attributing it to a lack of contraceptive awareness. Over 73 percent (97 patients) reported no contraception usage and stated unawareness of contraceptive methods.

In 54.55 percent of cases, pregnancy was confirmed, with 9.09 percent unaware of it. Per vaginal bleeding was observed in 100 percent of cases, followed by abdominal pain in 96.55 percent.

Only 10 patients had underlying medical conditions, two with endocrine disorders. About 92 percent (122 patients) required hospital admission, and 88.64 percent underwent surgery. No patients had a trauma history or showed signs of infection.

According to the study, 65.91 percent (87 patients) were married, 16.67 percent (22 patients) were unmarried, and 11.36 percent (15 patients) were cohabiting. Also, 38.2 percent of the women were primigravida—pregnant for the first time, while 55.30 percent (73 patients) had stable employment.

Married women expressed a desire to delay or space pregnancies, according to the authors. The authors added that women with living children had more miscarriages, possibly due to considering their family complete and preferring an average-sized family.

To prevent unintended pregnancies and associated health risks, the authors urge policymakers to improve contraception services, offer sexual health education to unmarried and cohabiting women, and provide contraceptive counseling to married couples.

“Seventy-eight patients had spontaneous miscarriage, while the remaining 54 reported taking abortifacients as they were not ready to start a family or their family was complete,” said the authors.

No deaths were attributed to miscarriage. However, the study showed that 4.10 percent experienced shock, 3.28 percent required IV antibiotics for sepsis, 14.7 percent received blood transfusions, and 1.63 percent needed ICU admission.

In the study, 71.21 percent of women had secondary education and above, with 15.9 percent having no formal education. Also, 73 percent of women who experienced a miscarriage were employed.

“Women with more education may be motivated to invest more time in their career and do not want unplanned pregnancies. This could also be the same reason for women who had miscarriages in this study,” said the authors.

Miscarriage, or pregnancy loss, is a nonviable intrauterine pregnancy up to 20 weeks of gestation, mostly occurring in the first trimester. It is more common in developing nations than in developed ones. Bhutan has made significant strides in reducing maternal mortality, meeting the Millennium Development Goal.

Induced miscarriage is illegal in Bhutan. Medical termination of pregnancy is allowed only in cases of rape or incest, when the pregnancy jeopardizes the mother’s life, or when the woman is mentally unsound.

In 2019, Bhutan reported 1,271 miscarriages, resulting in three maternal deaths. Evacuation and curettage were the most common minor procedures, with 338 performed for miscarriages out of 761 minor procedures in the same year.

Miscarriage is a major health concern, contributing to maternal morbidity and mortality. WHO reports an incidence rate of 39 per 1,000 women aged 15-49.